032-540-28-5510-LUP-2004-125 Application for Land Use Permit •�����''`� o o .
County of Sawyer � ;�� �
PO Box 676 -Haywazd WI 54843 . �
715/634-8288 �
The undersigied hereby makes application for a Land Use Permit and agrees that all work
shall be doae in compliance with the requirements of the Sawyer County Zoning Ordinance �
and the laws and regulations of the State of Wisconsin.
NO CONSTRUCTION MAY BEGIN UNTIL ALL PERMITS HAVE BEEN ISSUED.
PRINT-USE BLACK INK OR PENCIL �
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Owner Builder C �
2ZI S. P�mac S+re�t \ �� �
Mailing Address Mailing Address I O
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City,State,Zip City,State,Zip
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�Ol �-{�Z y3ZC7 � � 0 ���✓z-SYBgb
Day[ime Phone Daytime Phone
Additional Information:�n er.'ii/e�J��d�'� Zone District R-'� -F
l,J�llua-w�a �1�icc b� C�uKl4
�l G! W �o/��i ��d Lot Size _�oqq2�1 S4. �•
7owsch, /✓la.ryla+u� z�zo�/ D
Date lot was created Acres �. ��
Is the property in a Shoreland District?(within 1000'of a lake or pond,within 300'of a river,
creek or stream) If yes,how far from the shoreline&water name:
Is there wetland near the proposed structure?If yes,how far N(�O�}- • n
B
Building Land Use b 9
❑
�New ( )Filling Floodplain:( )Yes OC)No # ;;
( )Addition ( )Dredging � �
( )P.lteration ( )Grading Chippewa Flowage: ( )Yes (j�l No � ,��,
( )Moving On ( ) r"
( � ( ) Driveway:( )State ( )County�Town Rd. �
I I,^
Primary Structure Accessory Building Addition � ��
Qg Dwelling QQ Garage-attached/detach O Deck
4Q Year round (�#of car stalls ( )Porch �
( )Seasonal ( )Storage Building ( )Enclosed
Q{f Frame built on site O Screenhouse O Living room � p"
( )Modular/manufactured ( )Greenhouse ( )Kitchen �
( )Mobile/manufactured ( )Other ( )Bedroom
( )Other primary structure ( ) ( )Relocate/enlarge
� � ( ) ( )#ofnew a
�
�
AdditionalInformation: ro IN
m �
Type of Construction �
Q{f Frame ( )Log ( )Pole/metal ( )Block ( )Concrete �
� )Other----------------- - U� S
Construction Cost:Primary Structure$ (Z.O� 000 �
O I
Accessory Building:$��DOO Addition:$ Z
c i dr��� �7y
Vo176Z. Pg 1_�ofDeed CertifiedSoilTest#_ �/"L�, � �
CSMVoI Z� Pg3Z7 Lot# bo8`7 SanitaryPermit#_ Q�/ 'C�`�y
Plat Envelope Or: �
Condo Vol Pg Year Installed
Aff of ex septic Vol Pg Owner When Installed:
Gard Gazebo Vol Pg
PreviousVariance: LUP: InspectionDate: a1„y�Da
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Describe the construction using these columns.List the dimensions of each structure in a separate
column.List each story,each addition,each alteration in a separate column.
#1. #2. #3. #4.
Size 3� ft.wide _g_ft.wide Z ft.wide 3� ft.wide
iucwv
3� ft.long ��ft.long (CARPORT �-16 ft.long 3� ft.long
Floor azea (A QQ sq.ft. �Q sq.ft. I�O sq.ft. �IOO sq.ft.
Hgk from grade 2.�to peak Z�p� ft.hgt. 23 ft.hgt. $_ft.hgt.
Stories I�z � �L stories � �2 stories � stories
#ofbedrooms�_ $EASONPA— wA�K our
MAIN PART F{OUSE'i FrmNT Po�CN GARAG� BASemeNT FoR.
Lot Line or Lake/River name: M hl N Pp,QT U5�
P�e�sp re�fr �o en c�ost� tay�a ,s� �ueY rna,�°
FbV' �e�-4i�5 e -�or Stpt;c sys-It..+, Wel� /O�Frnr. 13�a�9
[/ encLoseo� P/of ��an Q�""'be� ,3o'�ro�- septT
S. I�o�se 79� Fro� l��s�. w�tcv oF Cake� /'�ue� +aKK
(P, l�On[ p-Fticv �l.c�� tio�sc•9 aray e S;tes
-7, No�s� .i- cJ�lr45c ba�l-� (06 �-f'ro�+. we-flc�
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Fire Number and Name of Road�no�I � 'S'tf') ' 3�Z�o_����1�t'a" �►��
1.Fill in lot dimensions and indicate north by arrow. Signature of Owner or Authorized Agent:
2.Indicate location and size of existing and new structures. �y i/ • /���
,��Gttl+` �/
3.Indicate location of well,septic tank,drainfield. v
4.Indicate distance to existing structures,lot lines,septic system.
5.Indicate distance to the ordinary lugh-water mark of any lalce,
pond,river,stream,creek,and name the body of water. PnntName:C11.����+S• ��kla �Y'.
The above certifes that ihe listed in(ormation and inten6ons are
6.Indicate any grading or clearing in excess of the construction site. �ess�io me P�e�y roo s c rsnsPeanoneby 9��e Perm�ss���ror
7.Indicate distance to any wetland.
Permit Fee: a a
/vl��� ��lJo:� d- ,, , d 7�'
5/4/04 ' —
Issue Date Signature of Iss � g g nt
May 4, 2005
Expiration Date
Office Comments:
Inspection Date: 50%Rule Applies: Avg.Setback: Within Reservation boundaries:
Restrictions and other information:
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� / � SURVEYORS CERTIFICATE:
� I, JEFF W. AIULOCK, WISCONSIN REGISTERED UND SURVEYOR. HEf
� � a, �� CERTIFY THAT I HAVE SUR'VEYED, AND MAPPED A PLAT Of' SURVEY
�Y LOCATED IN GOV'T. LOT 5 OF SECTION 28, 740N, R5W, iOWN OF
O� � � WINTER, SAWYER COUN7Y, WISCONSIN.
� � a � THE ABOVE �ESCRIBE� PAFiCEL CONTNNS 7.71 ACRES OF V.N� N
. � OR LESS AND IS SU&IECT TO ALL ElSEMENTS AND RESEftVATI0N5
� RECORD.
/ a � THIS SURVEY WIS MApE IN COMPLIANCE WfiH CFIMTER !.E-7 OF
� WISCONSIN ADMINISTRATIVE CODE AND THE MAP IS A CORRECT
� REPRESENTATION OF THE Sl1RVEY MADE TO THE BEST OF IAY
� KNOWLEDGE AND BELIEF. THIS SURVEY WAS MADE UNOER THE
� DIRECTION OF KEN FULLER.
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sa:�,t 6y: SAWYEF CCUNTY Zonlnc; 715638 3277, �ay-3-04 6:50PId; Fac_,e 1!1
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� S}iQRELAIYA PRESERYATION AGR1�:�MENT
N (Shoreline Veeetstton Protectioa Area)
�U Land Uae Permit No.�(ro be eniered by the'Loning Office) Index No. �7 - ��
�
� FVF�EREAS,(list all owneTs) 11/����clvr) �. [',�jct J r� -
.s� E �za b�+e. M 9��e lln C'�kl�
3
�% owne real esGlte within 5awyer County that is subjcct to the 5awyer County Shoreland Regulations, and
� WHEREAS,in ordcr to secure a Land Use Permit.
� NOW,TIiEREFORE,the owner(s)hereby certifies that,as a condition of issue of said Land Use Permit,that
v t6e SHORELINE VECrETATIDN PROTECTIUN AREA ou said eeal estate is intact to n minimwn depth nf
35'landward from the ordinary hi�kt-water mark of Ute waterbody.
�� 7'he owner(s)hcreby agrees to comply with ihe shoreland vegetative protection area reyuirements of Section
4.410 SHOREI.AND VEGE'I'AT]ON PROTECTION AREA,Sawyer County Zoning Ordinancz,in effect on
� the date that the land use pznnit is issued by the zoning office.The ownar(s)furttier agrees t4 allow authorized
� representarives of the Govemmental Unit to enta onto the owner's pmperty at the following description
O betwcen the hours of 8:00 A.M.and 6:OQ P.M.[Section 9.13(S)POWERS,Sawyer Counry Zoning Ord�nance)
to inspect the structuee(s)or uses authorized by said Land Use Permit and m determine if the SHORELINE
VEGETATION PROT'ECTION AREA exists and thst it is being preserved.This authorizaUon shall terminatc
on the datc o£�cpiration of thc land use permit. However,tha owner's obligation to maintain the SHnRELINE
VEGETATION PROTECTION AREA in accardance with Sectiou 4.410 SHORELAND VEGETATION
PROTECTTON AREA,Sawyer County Zoning Ordinance ranains in effect.Violstion of this Agreement will
authorize, in addlUon t0 other penaldes and celief required under the Sawyer Cuunty Zoning Ocd'Ittattce,
injunctive relief,restoralivn of said real estate,thc rcvocation of said Land Use Pemiit and the removal of ail
shvcpues approved by We issue of said Land tise Permit and the revocation of any othcr uses approved hy the
issue of said Land Use Yermit. All parties agree that this AgreemenY sha11 be filed with the Sawyer County
7.oning Office.
Legal Descripfion of Property: ���t. LC t s 'F �C�i 0 H a S T yD N ,�s w
nataa�s �3 day of <,. > �o o y
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�o.�a�) (o,��)
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��� (Owner)
(Owner) ((hvner)
This i�trument wes drafted bY. �-- --_. ._—.. .— ..-- .—. ..
SawyerCounryZoning0[Cice .5'3WYCC C011rity GOtllll�AI�Clllil
PU 130%6��
Hayward,bVI 54843-0G76